MGU 386 | Medical Insurance Literacy


We can’t know it all. And when it comes to insurance, it’s a never-ending list of clauses, qualifications, requirements, and exemptions. With all the different types and providers, it pays to have medical financial literacy. Be aware and listen in as dedicated patient advocate Dr. Virgie Bright Ellington shares important insights on the what, where, hows, and everything else you need to know about insurance. Find out what American citizens don’t know about medical insurance and how you can avoid the stress of surprise billing and the shame and guilt of debt. Make sure to tune in to get a better understanding of how insurance can get you covered or not, and how critical it is to listen and trust your inner voice when it comes to health and finances because you don’t want to wait until it’s too late.

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Know Your Terms And Coverage: Developing Medical Insurance Literacy With Dr. Virgie Bright Ellington

I feel like I say this quite often on the show whenever I have a guest, which is that there’s so much that happens in the conversation before we start. That usually leads me to the very beginning of a conversation. With Virgie here, I am thrilled to explore a number of different topics. Virgie, I hope that I’m pronouncing your name properly because it suddenly got into my head. Did you say that some call you Vergie versus Virgie? Is that incorrect?

I have to be honest with you. People can say Virgil, but they can’t save Virgie. I’ve never heard anybody call someone Virgil, but they want to call me Vergie. It’s ever since the Black Eyed Peas several years ago or whenever came on the scene with Fergie. It drives me nuts. I have to say, “Virgie, forgive them if they can’t help it. They’re not literate. Don’t be judgmental,” but it drives me nuts. I’m like, “If you can’t say Virgie, if you think you’re going to have an issue with it, please just call me Virginia. I won’t be insulted.” They’re like, “Is Virginia your real name, your legal name?” I’m like, “No, but it’s better than Vergie.”

Virgie is your legal name. This is a thing with names. It has come up with many guests on this show where I might mistakenly mispronounce. Even if I ask somebody ahead of time, I’ll get in my head and I’ll start questioning it. It’s a great opportunity to ask somebody how they want to be referred to, how to properly pronounce their name, and be mindful of that versus making assumptions. That has been my big goal. You’re not on the show to talk about your name per se. Although you are also a doctor, so you can be referred to as Dr. Virgie. We are here to talk about a few different topics. One of which that I don’t think I’ve ever explored on this show before is medical debt.

I have talked about debt and finances, but I don’t believe the medical side of things has come up. If it has, it has been lightly addressed. When I was looking over your work before you came on the show, I felt compelled to discuss this because they’re somebody who I’m close with, who I’ll keep their identity private, who has been experiencing a challenging time with medical debt. I’ve gotten involved to try to help this person out. It opened my eyes to the system in some ways. I still feel quite ignorant.

It also opened my eyes to the challenges and the variables that can lead someone to that place. That could be not having insurance. In this specific case, I don’t believe this person had insurance, but they had a medical emergency. They did not have a choice or even advanced notice before getting a procedure done. I’m not sure if they were told at the hospital by a nurse that they wouldn’t have to pay for it or maybe it wasn’t going to be that expensive. This person had that in their mind and felt reassured.

I’m sure you hear this all the time, Virgie, they received not one but four different large medical bills. I got involved because this person also has some emotional or maybe developmental challenges around handling these things that feel extremely overwhelming. Plus, there’s a big trigger there because they had a traumatic experience that led them to the hospital in the first place. I can understand this too. When I have to deal with the aftermath of something traumatic, it’s hard because dealing with it again is also bringing up the trauma that you’re trying to move past.

You are just one illness or accident away from a lifetime of debt. Share on X

It’s that compassion I felt for this person in my life who was surprised by these unexpected bills, and then they are still to this day dealing with them. They’ve chosen to ignore it because they can’t handle the emotional weight of it. I don’t feel adequately prepared to deal with it, nor is it truly my place. That’s the backstory as to why I felt drawn to talk with you. I imagine that there are many people going through similar situations.

In that story, you summarized everything about what’s wrong with our for-profit healthcare system in a nutshell. I’m trying to figure out where to start because you summarized every great example of every issue that’s the problem with our for-profit healthcare system or with the for-profit healthcare system in the United States. I’m going to start out by talking about the perception that most of us have in this country that if we have insurance or I have great insurance, I’m okay. I’m protected.

What people don’t know is that for the overwhelming majority of Americans and the people living in this country, it doesn’t matter what your actual citizenship is, if you get healthcare in this country, you are one illness, accident or injury away from a lifetime of debt. That’s even those of us who think we have awesome insurance. This person that you’re close to that you’re describing, their experience is extremely common. They think, “If I had insurance, everything would be okay.” No, it doesn’t make quite a bit of a difference, but it can take the edge off it, which is the second thing I wanted to talk about and mention.

Even though having health insurance in this country doesn’t protect you from a lifetime of debt or stress or bankruptcy, it does protect you in some ways, and it does offer a layer of protection. I remind people, the number one thing that folks in this country can do who are in their 20s and 30s to ruin their financial future is to go without health insurance. I do want to encourage folks to figure out what they want to do in terms of having some basic health insurance.

If you’re under the age of 29, you can qualify in the Federal marketplace for what’s called catastrophic insurance. It won’t protect you if you get a nasty cold or virus and ends up with bronchitis and a cough that you can’t get rid of that has been going off for three weeks after the virus. When you have to go to urgent care for getting that cough evaluated, that’s not going to cover you. That’s going to come 100% off your pocket, but God forbid you have an accident and you’re on a bike and you hit a pothole and run into a tree or fall over the bike as I did, I wasn’t paying attention and went headfirst over the wheel, catastrophic insurance may save your financial life.

The other thing is that we think it’s not going to happen to us when we’re young and beautiful. It’s like, “I’m healthy. I bike. I workout. I’m awesome. I don’t have any family history of problems,” but life happens. You don’t want to gamble on your financial future. One accident, injury or illness, and you’re done with all of the hard work and savings. It will wipe you out. That’s one thing you can do if you’re under the age of 29.

MGU 386 | Medical Insurance Literacy

Medical Insurance Literacy: People really feel guilty when they have medical debt, and it’s not their fault.


The other thing is if you’re over age 29 or heading towards your 30th birthday and you don’t have insurance through your employer, you’re not employed, you’re self-employed or you want to be self-employed, then you would go on the Federal marketplace, the ACA, Affordable Care Act or what people call Obamacare Marketplace. Decide what you’re going to do and what you can fit into your budget.

I’ve also heard that when people go to the Federal marketplace like the ACA or the Obamacare Marketplace, they think that the platinum, gold, silver and bronze levels mean different levels of care. No, it’s the same quality care that is required or the minimum standards that the insurance companies who participate have to meet. The difference in levels is how much you have to pay in your monthly deductible, but here’s the catch, the lower you pay in your monthly deductible, the more co-insurance, meaning a fraction of the bill that you’re responsible for.

The lowest monthly premium is usually the bronze plans, but they have co-insurance of 60%-40%. Meaning if you end up in the ER and you have a bronze insurance plan, you’re going to end up with a bill. Let’s say that bill is $5,000, which is not unusual, unfortunately, especially if you have an accident and you end up in the emergency room, and that’s not even counting if you get hospitalized. The insurance company will cover 60% of that bill, but you’re on the hook for the other 40%. You’re looking at $2,000 right there that you’re on the hook for. Whereas if you go up to the platinum level, that has a high monthly premium but the co-insurance maybe 90/10 or something like that.

I want folks to be aware. That is something you want to think about. Please don’t go without insurance. Figure out something that you can squeeze into your budget. If you don’t have a chronic health issue, then go ahead and go with the lowest monthly premiums if you don’t have to interact a lot with the medical care system. We are gambling that the issues that will come up are going to be rare and I’ll be stuck on the hook for that 60%-40% co-insurance. If you have a chronic medical problem, then you want to go and say, “I got to figure out how to get as close to platinum as I can because I don’t want to be on the hook for 40%, 30%, 20% every time I interact with the medical care system.”

I wanted to talk about those insurance issues. One more thing. I didn’t want your friend or loved one to feel that if they had insurance, everything was going to be okay. It’s likely not because of many things. For instance, something called surprise billing with insurance until 2022, January 1st. You can have great insurance, has an emergency, and goes into the ER. I live in the neighborhood where I know that this hospital takes my insurance. They’re in network with my insurance, but the ER doctors who are employed by the facility are not. They do not participate with your insurance. People would go bankrupt from surprise bills, which is surprise billing.

When you go to an end network facility for care, you don’t have a choice over the doctor, ER, or anesthesia if you had to have emergency surgery. You’re like, “This hospital takes my insurance,” but you don’t know that the anesthesiologist does not. There are private equity for-profit corporations that would make money on that. They built their business model over hiring docs who won’t take insurance. They would say, “We don’t take insurance. You have to pay us. You owe us whatever our bill is.” They would make up crazy numbers. That’s how people go bankrupt for medical bills, and they had insurance until January 1, 2022. That’s not necessarily for your loved one to feel bad that he or she didn’t have insurance. People feel guilty when they have medical debt. It’s not their fault. I had to get that out of the way.

The number one thing you can do to ruin your financial future is to go without insurance. Share on X

Thank you for that. I want to pause there because that’s such a helpful thing. It’s the shame that can come up, the guilt, the wondering what if, and the trauma of that too. That’s another layer of trauma. It’s not just the bill reminding you that you went through something possibly traumatic but it’s also the trauma of unexpected financial struggle.

When I was in college, I remember going to the emergency room for something minimal. Talking about ignorance too when you’re bringing up age. I had just moved to a different city and I had a small issue. My mother was like, “You should go to the emergency room.” It was a Sunday. I couldn’t wait for an appointment during the week. I went in and I remember it was a quick visit. I told them what was going on. They gave me a solution. I was in and out of that room. I had to sit in the emergency room for quite some time and see a nurse. I’m not even sure I saw a doctor. It was quick, then I remember getting the bill.

I was just getting started. I can’t remember if I was still in college when I got the bill or where I was in that timeline. I wasn’t working. Even if I was working out of college, I was probably just getting my feet wet and trying to figure out everything and already feeling overwhelmed in my life. That’s another thing. Sometimes these bills come up when you’re dealing with so much already to add that extra layer on top. I remember calling them, crying and saying, “Why am I getting this bill? I didn’t expect this. They didn’t tell me at the front desk it was going to be this much.” They were like, “I’m sorry.” They couldn’t do anything. At least I didn’t know back then. I could have done anything, which is where your book comes in and your expertise. Thank goodness.

Most of us don’t know that the emergency room and anything affiliated with the hospital is the most expensive place to get care. Unless it’s life or limb, you got something in your eye, a vision issue, you’re having chest pain, you see your life flashing in front of your eyes or you think a limb could be broken, then you go to the ER. It’s for an emergency. It’s not for urgent issues. Urgent care is for urgent issues.

That’s helpful too. Looking back, it’s easy in hindsight for me to recognize that. Thank you for spelling it out clearly, but my heart goes out to people who panic. Not only could you end up in that situation, but then you start to associate medical care with something complicated, overwhelming, or you say, “I can’t take care of my body right now. I have to wait to get care because I can’t afford to get care right now by going into the emergency room.”

I’ve only been to an urgent care center once. I was surprised at how great my experience was. The urgent care I went to was covered by my insurance. It ended up checking off all the boxes for me. I don’t know that much about urgent care. They seem a bit of a mystery to me. They seem like they run independently. They don’t make sense. Can you explain what urgent care is?

MGU 386 | Medical Insurance Literacy

Medical Insurance Literacy: Access to basic medical care for everyone who wants and needs it is a public health issue.


The physicians and healthcare providers often use a lot of physician extenders like PAs, nurse practitioners and urgent care facilities, which is fine because they’re staffed with medical care professionals who know, “We need to get the doc in here.” Thanks for bringing that up. I know that urgent care facilities are like a mystery to folks because historically, they didn’t exist. You’re traveling and everybody went to the emergency room because they’re like, “I don’t know. There’s a hospital. I can look up where the nearest hospital is with an affiliated emergency room. I’ll go there if I’m having UTI symptoms or bladder infection symptoms.” In the past, 15 to 20 years, urgent care is ubiquitous. When you cannot wait, that’s where you want to go. You know it’s not an emergency because life or limb or your eyes aren’t at risk.

That’s helpful. Thanks for clarifying that. You touched upon travel too. I’m curious about that. I traveled a few months ago and I bought travel insurance. I looked into a few things. It seemed like my insurance, which is basic, was not going to cover it. Maybe they would, but it felt a little risky and unknown. I also looked into my credit card. I have a travel credit card that does offer some coverage. I added travel insurance as an extra layer of protection. I felt ignorant when I was shopping for it. I did a little of the comparisons. I looked up some reviews. I was surprised pleasantly at how inexpensive it was. It was like $16 to cover me for two weeks or so of my travels. What are your perspectives on travel insurance? Is it worth the money?

Absolutely, because insurance generally doesn’t cover care outside of the States. If you’re traveling, invest in insurance. You buy insurance for something that you can’t afford to do or replace. Whenever you go to the electronic superstores and they say, “Do you want to buy insurance for your laptop, TV or microwave?” You’re like, “No, I’m not going to like it if something happens to my four-figure, big, huge, giant screen TV. I’m not going to appreciate it and it’ll hurt, but I can afford to replace it and/or make the choice to replace it if I choose to. Maybe I’ll do something less expensive.”

When it comes to things that we cannot replace like our homes, we get home insurance because if something happens to the house like a fire or natural disaster, you can’t afford to rebuild the house. Car insurance, you can’t afford to replace your car, God forbid if it’s totaled. That’s what insurance is for. We can’t afford to pay 5 and 6-figure medical bills. If something happens, God forbid, we get in an accident while we’re traveling or we become ill while we’re traveling. Please invest in travel insurance because, in the States, I can’t think of any insurance that will cover you when you’re traveling.

That’s Medicare and I don’t know about Medicaid, I can’t say because states vary. Medicaid is state health insurance. Medicare is insurance for those aged 65 and older in certain chronic illnesses like if you’re on dialysis. Medicare does not generally. There are very circumscribed cases where if you live close to the border with Canada and you get hurt, injured or sick, you need to get transported to the nearest facility on the Canadian side. Sometimes but not always, the Canadian facility will submit a bill to Medicare, but you’re on the hook for it. You’re going to have to submit that claim to Medicare yourself.

These are very limited issues. It was an emergency and you got to the nearest facility. Other than that, no. Private insurance, commercial insurance, and health insurance doesn’t pay for care that’s administered outside of the States unless you have a rider. Some people get riders if they travel a lot. If you can afford that, look into getting a rider.

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What is that?

Thanks for asking. A rider is a supplemental plan in addition to your primary insurance plan that they offer for an additional fee that will cover a special event.

You mentioned chronic illness. I wanted to circle back to that because I don’t have any major illness that I’m aware of. Thank goodness. Looking back over my history, I certainly had some things that were ongoing. Many of us struggle with things that are a little bit more on the subtle side. For somebody who has an illness or a condition that is impacting their day-to-day life, I don’t have a lot of awareness of that, especially when it comes to money. It feels likely unfair because they’re probably going to fall on the more financial burden. Is that correct or are there systems in place in the United States that can support people for something that they can’t help? It’s not an accident. Maybe it’s something that they’re born with or they develop over time. What financial situations do they typically have to deal with?

I’m trying not to laugh, Whitney. I’m like, “Isn’t she cute?” It would be nice, but no. We’re in a for-profit system for healthcare in this country. Let’s be clear, we risk dying or an early death if we can’t pay for our medical bills. There are multiple studies done by different folks. One was released where the statistics show over and over again that people with medical bills, medical debt or who can’t pay off the bill right away are less likely to get care because they’re like, “The more I interact with the care system, I’m going to rack up another bill. I’m going to try to hold out.”

They have to speak if they have a chronic illness and they have to be on medication to keep them alive, frankly. They will say, “It’s expensive. I’m going to try to save some money by taking the pill every other day instead of every day that it has been prescribed.” What do you think is going to happen? They’re going to end up sicker and with more bills when they crash and burn. They end up in the emergency room. No one asks to be injured or sick. That’s why the Federal government and I think this administration has tried to say, “We’re going to separate out medical bills and debt from consumer debt because no one asked for it.”

It’s not student loans. You didn’t say, “I’m going to take out a loan instead of maybe doing some service for my country in exchange for an education like the GI Bill.” You didn’t sign up for student loans. Just like what we do with student loans, we didn’t make that decision. We didn’t sign up for medical loans and medical debt. No one wants this. It’s not your fault. It’s not our fault when we’re sick or injured.

MGU 386 | Medical Insurance Literacy

Medical Insurance Literacy: Listen to your gut. If it doesn’t feel right and you’re not sure why you can’t articulate it, it doesn’t matter. Listen to it and figure out what works for you.


Americans do feel shame and guilt when they have medical bills and medical debt. I don’t want to sound conspiratorial, but the data is showing over and over again that the system is created because it’s a for-profit system. Eventually, it’s created such that folks are going to have a debt to be able to carry and pay for it. You’re going to have bills. If you have enough resources like anything in this country, that’s for-profit and you can afford it. If you don’t have resources or financial resources, loan in your SLO.

I appreciate how frank you are. Tiptoeing around big issues like this is not doing us any favors. There are a lot of people that are struggling financially, especially here we are towards the end of 2022 and there are a lot of concerns about inflation. There are a lot of talks about student loan debt and other forms of debt. It’s on people’s minds about what they do when their income stays the same, but everything becomes more expensive. People are concerned about housing, then you add in medical care. I wonder how many people are not taking great care of themselves because they feel like they can’t afford it.

That’s something that I’m also working on raising my awareness around because, for a long time, I felt like I’ve always been able to take care of myself. I had that mentality even when I didn’t make as much money. I would think, “I could still afford this or that,” and then I started to get exposed to my privilege. Not everybody is living equally for a variety of different factors, whether that’s marginalized communities or whether that’s how you were raised at home.

A healthy family of origin.

This assumption too. I hear these arguments around government policies and some people feel outraged because they don’t want to have to pay for somebody else’s medical bills.

That cracks me up. I laugh so I don’t cry. I find it interesting. We just came out of this major life event that affected the entire planet and we still didn’t figure out that it’s a public health issue. Having access to basic medical care for everyone who wants and needs it is a public health issue. I don’t want folks who don’t have access to healthcare driving the same buses that I ride, me and my loved ones, driving on the same streets, walking down the same sidewalks, walking in the same stores, and flying in the same planes because we found out that what affects one of us does affect us all. It is not just a trite saying.

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I’m a physician. I’m a scientist. I believe in the Law of Gravity. I believe in science. A rising tide does lift all boats. It’s the Law of Gravity. If we don’t think of using our taxes or paying taxes so we contribute to the police, our law enforcement for keeping us safe, fire protection, libraries and public schools, that’s not socialism. How are we making sure that everyone has public health so that me and mine are safe? I don’t understand how that’s socialism other than maybe a catchword or a political catchphrase. You’re going to get me on my soapbox here. It’s a public health issue. We need our taxes to go toward public health and public safety. Public health is part of public safety.

I love your soap box. I hope that you continue on there because this is important. That’s beautifully said about public health is public safety. That’s something I’ve also had the privilege of not thinking that much about. I love the way that you outlined that because it’s interesting how in our country, there are elements in which we are encouraged to come together, and then there are times when we’re told to fend for ourselves and look out for ourselves. It’s not this we’re all in this together mentality. It’s every man for himself mentality. That can be dangerous.

It’s kumbaya. It’s all good. All kumbaya until money, resources or whatever gets tight, and then stuff gets ugly.

That is true because finances trigger people. A huge part of this conversation is that if you can feel concerned about your own resources, can you not have empathy for somebody else who’s likely concerned about theirs? It’s such a complex issue because people are making much larger amounts than others and how they get there. Some people think, “I work so hard for this. Why should I share it?”

Most people work hard, but not everybody has the same opportunities. Not everybody has the same fortunate family of origin. There are some people with horrible, dysfunctional or no family of origin, but they get into a system or someone looks out for them and helps them. The American mantra of pulling ourselves up by our bootstraps and working hard and it’s a meritocracy is not true. When you think about it, you have to have some fortune or privilege.

Maybe it’s the fortune of having somebody if you didn’t have a great family of origin, you’re on your own and in the streets or you’re in the foster care system through no fault of your own. Someone looks out for someone. There’s always someone in someone’s background who said, “This person found me and paid for my education, made sure I had a place to stay or made sure I had at least one meal a day while I was working under the table for cash.”

MGU 386 | Medical Insurance Literacy

Medical Insurance Literacy: Make sure you’re not overcharged and don’t spend money or pay for services you do not owe.


You mentioned that there is a lack of understanding and empathy for folks that don’t have resources. In this case, we’re talking about resources to be able to afford medical care. It’s only in a for-profit system where that’s required. At the end of the day, there’s a saying, “If a man’s livelihood depends on his not understanding, he’s not going to understand.”

The US healthcare system is $1 trillion in total medical debt throughout the whole country. It’s probably even more in terms of how much the revenues are generated or the GDP that the healthcare system in the United States represents. That’s a lot of money for a lot of folks. If you threaten somebody’s livelihood, they’ll cut you. They’ll kill and destroy you. It’s all kumbaya. It’s all good. Everything is awesome when everybody has enough, but when resources get tight or someone’s resources are threatened, not so much.

We also have other threats. We saw this come out during the pandemic in some interesting ways in which some people felt like their freedom was being taken away because they were asked to do certain things like stay at home and wear a mask. Looking at how some people reacted to that, and I don’t mean to make this a conversation to get on one side or another. There are people here that might not feel comfortable with certain things and they believe in these different things than I do. I did find it interesting how personal some people took these things. I felt moved and saddened by the conversations that people who are immunocompromised were having. They were saying, “This isn’t just about you.” When you’re making some of these choices, it’s impacting other people who may not have the same health as you do or who might not have that privilege.

Public health is public safety. I have a family member who’s an adult that has type one diabetes. Type one diabetes by the way is different from type two diabetes. In type one diabetes, you don’t make any insulin whatsoever. With type two diabetes, you still make some but not enough. The problem with type one diabetes is that if you get a little bit sick, you don’t have enough insulin to overcome the reaction in your body that happens from the stress of dealing with an illness. That’s why they’re at high risk of complications or unfortunately even down the road, worst case scenario, even death. Severe complications if they get a minor cold or upper respiratory viral infection for those who don’t have type one diabetes.

I don’t think that she knows that I know this or that her other family members know this. There were times when she figured out somebody in her family had gotten COVID, she cried because she realized that she was going to have to quarantine with them. Maybe she already has COVID. She was afraid. It affected her being able to travel and see her family. It affected her being able to get an education because there are some people at that time in the pandemic who did not want to wear a mask and found public safety issues. It makes me laugh. I laugh again so I don’t cry. Why do we have traffic lights? It’s a public safety issue.

You wear a mask when you have a highly contagious respiratory transmitted virus pandemic. I don’t understand. To your point, Whitney, it’s an issue where we have to think about others. It’s a public health issue. Early on in the pandemic, I saw a study that someone had done, looking at Brazil and maybe a part of the US, and I don’t know why they chose Brazil. They looked at people. They had them take a questionnaire. It asked them how they felt about wearing masks. That’s like assessing if they meet criteria that would determine that they have a certain personality disorder. It turns out that people who have more sociopathy are more likely to have a problem with wearing a mask, not wearing a mask, and not staying home when they think that they could be sick or infected.

We risk dying if we can't pay for our medical bills. Share on X

I’m not surprised about that. It’s easy to get into debates and people to get defensive over their beliefs and all of that, but there are many different perspectives that you can look at things. It reminds me of something I came across through the emotional well-being training I’m going through. I was sent this little reflection exercise about finding out what biases, views and beliefs I carry. It comes from Culturally Responsive Teaching & The Brain by Zaretta Hammond. It’s an exercise in which you can go through and reflect on things like your ethnicity, your race, the story of your family, your economic status, and your traditions, and start to gain clarity on things that impact us in such big ways.

We’ve been talking about privilege and belief systems. Sometimes we get to this point where we feel like that’s such a personal issue. What I love that you’re bringing up here is the impact that has on others publicly, on our safety, and the ripple effects. Even emotionally, when you’re bringing up this family member, it breaks my heart hearing that and to imagine somebody crying because they’re afraid for their lives based on some action that someone else took that they saw is casual. I don’t believe this to be casual.

I am an independent person. I make my own choices. I’m an American. All of those things. There are folks who live outside of the States who may or may not be American citizens. It doesn’t matter, but there are some people who feel that you’re infringing on their civil rights by saying, “You have to wear a mask to protect yourself and others from this highly contagious respiratory transmitted viral infection.”

We don’t have to get deep into this, but it’s interesting some people don’t do that not from a civil rights standpoint, but they don’t even believe that there’s an issue happening here.

There’s always going to be that. That’s a different story for a different day.

It goes into this conversation around misunderstandings, not understanding the system, and having different beliefs about what’s going on in the world. How are we supposed to come together and find a system that works when people are coming at it from all these different angles and beliefs?

MGU 386 | Medical Insurance Literacy

Medical Insurance Literacy: The for-profit US healthcare system understands that 99.9% of the American public is not medically financially literate, and they take advantage of it.


Just because I don’t believe it doesn’t mean it’s not true. There are people who believe that the world is flat and it’s not true. There are people who don’t believe at a certain time in history that the world was round and it turned out to be true, but it’s your belief system. It is what it is. Whether you believe it or not, it does not mean that it’s true or not.

If you want to depend on science to keep you safe like the engineers doing traffic studies, determining appropriate speed limits, where to put traffic lights, and that kind of thing, if you depend on scientists to tell you, “Historically, since the 18th century, putting antibodies to something and having you develop an antibody to something before you get exposed to the real deal in a big load to make you sick has been shown to be protective.” You don’t have to believe it, but it doesn’t mean that it’s not true. We can’t help folks that have their own belief systems. However, with that said, what you’re saying is that we have to protect everyone from people who may not have the same belief system, who may not believe in science and engineering, and who may not be so into STEM stuff.

This brings me to something else I’ve been wanting to explore with you, which is going with your gut. There are many ways that we could tie this into this conversation because as a segue from this conversation around COVID, there were times in which it’s hard to go with your gut if you’re in a social situation where other people seem to be acting differently than you deep down want to believe. There are also times when you don’t know if you can follow your gut because maybe you don’t feel like you have enough information, or maybe you don’t have the right information. Sometimes you wonder, “Is my gut right? Am I following some old belief? Is that based in fact?” How do you know when to trust your gut when it comes to something medical or financial related?

There are a lot of layers there that we can dig through. First of all, we’re often socialized in this society or the general culture of the United States and the West. We are cultured to listen to others outside of ourselves. Especially in this country, we tend to be extroverted. We value extroversion and extroverted folks. When you’re thinking about things outside of yourself, taught to socialize, and brought up and conditioned to listen to things outside of yourself, you’re not going to be able to recognize your inner voice. You’re not going to be able to hear it. If you haven’t heard it, it is drowned out by outside things. If you’ve heard it, you’re not sure what it sounds like.

There’s a saying that God speaks to us. God is the universe. The truth speaks to us in a whisper. The more you ignore it, the louder it gets until it gets your attention. Unfortunately, we will get to the point where we don’t hear it because we’re socialized to listen to external things or things external to ourselves. We doubt what we hear. We’re not sure what we’re hearing. We’re not sure what that voice is. We doubt what that voice is until the thing is so loud. Unfortunately, it’ll take you out of the system of things.

For instance, the story that we give often is my own story. To cut to the chase, I have been working for a large corporation. To be honest, I was a rockstar. They thought, “Virgie is doing all these fabulous things and all this and that. She’s training our clinicians to make sure they make accurate choices and decisions about making sure folks get the care that they need. Awesome.” Until I realize that I’m spending so much time and so many hours a week, making sure that this company has everything that they need that I was neglecting myself and my family.

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My husband had said something. He says, “You said that you like working from home because it gives you flexibility so you can spend more time with the kids and your family. You’re not doing that. You’re still working on weekends and long days and long hours.” I was working 60, 70, and 80 hours a week. I had a person who was important to me. She was my kid’s nanny who had been diagnosed with renal cancer. She was diagnosed with this kidney cancer after we had moved from where we lived before. She was no longer our nanny. We didn’t need a nanny anymore. She was working with another family.

I realized spending all this time working and focusing on the needs of this company and meeting their quotas. I had two jobs. One involved productivity and the number of cases I went through, which involved a quota. The other, which I loved and they loved me doing, was saving the company hundreds of millions of dollars a year, teaching folks to do accurate clinical case reviews, and making sure that folks got the care that they need and paid for.

I realized that I haven’t talked to her and checked in on her to make sure that she was feeling okay about her care and that kind of thing. She will call me once or twice if she had a question. I was thinking, “Virgie, you don’t have time to take care of and do the things that are important,” which is making sure I reach out to her once in a while and talk and check in with her instead of waiting for her. She knows I’m here if she needs something, but she shouldn’t have to wait until it’s an emergency.

I was thinking about that. Finally, it hit me one day when I was told that they needed me to do more. I remember thinking, “I am less than five years out from a breast cancer diagnosis.” I’m late for my annual screening mammogram. I don’t have time for my annual screening mammogram. Something in my gut was saying, “This is not right. Something is not right. I still have young kids. I have to make sure that I do everything I can to make sure that their mother stays healthy in this system of things, and to make sure that they’re okay until they grow up.” I snapped. I was like, “I’m out.”

I said to them, “You have to tell me what you want. I can’t do it all. I know I was hired to do this one thing, which is production, but you’ve asked me to do this other thing, which you say is awesome and you value and is bottom line financially valuable to the corporation, but I can’t do it all.” They hemmed and hawed. I was like, “Never mind, while you’re hemming and hawing, I’m late for my mammogram.” I’ll never forget this. My last day was a Friday. I was like, “I’m going to schedule my mammogram. This is going to be awesome. I’ll be able to rest, regroup, and do something else in terms of some other work and work for another company or maybe develop my own company.”

Less than one week later, the following Thursday morning, I got a call that my mammogram was abnormal. It was cancer again. I got a call in the afternoon from my nanny’s daughter who was outside of the country and had no way of getting back into the country and saying, “Virgie, my mother got admitted to hospice.” That was a Thursday. Friday the next morning, I got up. Every single day I would go and sit by her bedside unless I had to have a biopsy, something related to breast cancer or the issue that turned out to be cancer. Unless I had the biopsy or a day or two later when I was still recovering from the biopsy, I was still sore or something, those are the only days I missed.

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Two weeks after that, on a Wednesday, my children’s nanny died. Exactly one week after that, the following Wednesday, I had a double mastectomy to deal with cancer that I was told by the breast surgeon was still in the duct, meaning it hadn’t gotten outside into the bloodstream of the breast duct. I got a call from her the next day that she has gotten a call from the pathologist. The pathologist said to her, “I know I said that the margins were clear, meaning the malignant cells were not outside of the duct, but you only have 1 millimeter of clearance, 1 millimeter of healthy tissue separating the cancerous cells or the malignant cells from outside of the duct or into the bloodstream. I’m sorry, you’re going to have to go back in.”

We go back in and we clear everything out and it’s still fine. Margins are still clear. My point in sharing this story is that it’s 1 millimeter from the breast cancer that scares everyone. It’s called triple-negative receptors, which are notoriously hard to treat. That’s the type of breast cancer most of us are afraid of. If it had broken through the duct, 1 millimeter from breaking through the duct, I wouldn’t be here now. That was at the end of 2019. My kids would not have their mom here.

My point is to listen to my gut and realize that something is not right. I’m not sure what it is. External folks want me to do something, but it’s not good for me. Something is not right. I had to listen to that. My husband wasn’t happy with me saying, “I’m out. I can’t do this.” He’s like, “What are we going to do? I’m concerned about us being able to pay our bills. I’m afraid of not having enough resources.” I’m like, “It’ll work out but I need to be alive in order for it to happen.” I didn’t know that at the time.

My point is 1 millimeter, I was days from those malignant cells breaking through the duct and I wouldn’t be here now. That’s why I make a point of talking about listening to your gut. If it doesn’t feel right and you’re not sure why you can’t articulate it, it doesn’t matter. Listen to it and figure out what works for you.

That is a story that took some turns. I was not expecting it. I feel in this state of awe around that. This lesson that you’ve learned and are here to share is remarkable. I’m curious about that. What if somebody hasn’t fully learned how to trust their gut? Does our gut communicate with us? These levels of urgency. Did you feel like it was more powerful than ever? You mentioned a whisper earlier, and maybe sometimes our guts are whispering to us. In that case, it was shouting at you.

A shout is I don’t feel well. I can’t breathe. I go into the emergency room. The X-ray shows that my lungs are full of fluid. It is from malignant breast cancer spreading to the lungs. That is shouting. It’s meaning likely I don’t have a long lifespan in front of me according to statistics. You want to pay attention before it shouts. The louder it gets and gets your attention, it’s more traumatic. We were talking about trauma earlier. You want to listen when it’s still whispering because it’s before something happens or before it gets your attention to say, “This is not right. You got to listen.” I’m not sure and I couldn’t articulate to my husband why this wasn’t right.

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I said, “Something is wrong with this. I have to do this.” He came from a background of limited resources, less than no money. Being financially secure is important to him. For him, that looks like having a steady job, a steady paycheck, not having your own business, and working for a large company, meaning well established. He was frightened but I said, “I have no choice. I can’t go on. I’m not sure why.”

We have to listen to our gut because we can’t see. It’s dark. We can’t see what’s in front of us. We have to step out. People call it stepping out on faith and listening to the beat of your own drum. You’re listening to the beat of your own drum. It’s in your gut. You may or may not be able to see, and you still have to listen to it and follow it and say, “I don’t know where I’m going, but I’m going to leave where I am now and go someplace and sit right down quietly for as long as it takes until I figure it out.”

I love the way that you talk about all of these complex and challenging experiences that you’ve personally witnessed and with others. It has been such a beautiful conversation that we could go on and on with. Before we wrap it up, I would love to know, where does somebody start? They’re reading this and hopefully, they’re feeling a bit uplifted, empowered and inspired, but there’s still the matter of dealing with something. Maybe they came to this episode because they have medical debt and are looking for practical support. When we were talking before we start, you were explaining something that you have on your website that’s made it easy. I would love for you to share what you were telling me about it being something you could read and work on the subway.

If you go to, there you’ll find a free downloadable checklist of the three steps of the only right way to pay a medical bill. When I say the only right way to pay a medical bill, that is to make sure that you’re not overcharged. You don’t spend money or pay for services that you do not owe because 80% to 90% of every single medical bill generated in this country has errors. If you can imagine, they’re not going to be in the favor of us the patient or the public. They’re going to be in the favor of the provider and/or the insurance if you have insurance. You’ve got to learn the only way to pay a medical bill and protect yourselves and your family’s financial future. You could be devastated by not knowing.

We are the only industrialized country that requires medical financial literacy. In this country, without medical financial literacy, you don’t have financial stability. I tell people, “You can go to, and you can find the book there, which is an easy read. I specifically wrote it for the 4th to 9th-grade reading level because people think that if it’s something involved with medical care, it has to be complicated. No, if you can buy groceries in a store, if you can get your car repaired if you bought a car, new or used, and if you’ve bought anything at a flea market, you can provide your own medical care payments without getting gouged and maybe even save your financial life.

This book will save you hundreds of thousands of dollars if you’re diagnosed with an illness or have an injury or an accident. You can go there, You can find the book there. We have a masterclass and a video that you can download that will tell you in more detail like level two of what the book is. It’s less than 50 minutes long. Let’s say you don’t want to take the time to do that. The book itself, door to door, you could get on a subway and read it. It’ll take you less than two hours. Let’s say, “I can’t be bothered. I don’t want to do that. I don’t want to read a book about it,” then go to and download a free checklist of the three steps of the only right way to pay a medical bill, and save your financial life.

That is such a gift. I have a personal reason to learn this. That’s worth pointing out too. It’s not always about you. I’m not dealing with medical debt right now. Although I will say, it was something we didn’t touch upon, I do have some medical debt from my dog, but I have been strategic about it. I’m not concerned. That’s why it doesn’t come to mind. Pet insurance and pet medical care are whole other things that could tie into all of this. Aside from that small debt I have, for this person in my life, I feel inspired to learn because it’s not just about us as individuals. It’s about how we can take care of others.

By learning something, you can support so many other people. Sometimes somebody could come to you and you could share the link to a website like yours, Virgie, that could literally change someone’s life. It sounds insignificant perhaps in a moment if you’re not dealing with it. I have also said the overwhelm that people often face when in a situation, you could be that person to say, “We’ve got this. We’re going to figure this out.” When you shared that statistic about 80% to 90% of bills have an error on them, my jaw dropped when you said that.

Yes. People say, “Where do you get that number from? That can’t be true.” Don’t take my word for it. Do your own research. Look it up. I’ve seen many statistics that say 80%. I’ve seen some that even say 90%. Don’t take my word for it, but let me let you know. It sounds conspiratorial but because the for-profit US healthcare system understands that 99.9% of the American public are not medically financially literate, they take advantage of it and they send you bills. They call them bills, but they’re not bills. You pay them and think, “I’m going to have to get a HELOC, a loan on my home or spend all the savings I was using for a down payment for a home for my family. Get a loan or liquidate my 401(k) or IRA that I have been saving for my retirement to pay it off.” You may not know any of it.

That is reason enough because it feels to me like not just about you, but maybe by taking that action, you’re contributing to a ripple effect for the system of saying, “We’re not going to let you take advantage.”

You’re taking care of your family, friends and loved ones. You’re taking care of your loved ones. We’re taking care of each other.

Think of how much more good you could do in the world with that extra money, not just paying your bills necessarily, but would you rather put it towards the medical system that might be charging you unfairly or use that money to pay it forward in some other way? I feel the financial ramifications can be huge. Thank you for the work that you do. Thank you for taking the time to share all of this incredible information with me and on your website.

Thank you, Virgie, for being here. Thank you to the audience for taking the time to be part of this important conversation and consider how much this impacts us all. I feel deeply inspired. I want to get up and help this person in my life and pass it on, and also feel more equipped for myself because life happens. Unfortunately, it’s probably only a matter of time before I’m faced with something. If I can feel more educated about this now, I feel like it gives me some benefits in the future.

Thank you so much for what you do. This platform is super helpful, just having conversations about life and wellness. We’re all in the system of things together. None of us is going to get out alive. We have to take care of each other. By learning, we can take care of each other. A rising tide does lift all boats. Thank you for what you do. Thank you so much for having me. I enjoyed talking with you.


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About Virgie Bright Ellington

MGU 386 | Medical Insurance LiteracyVirgie Bright Ellington, MD, is an internal medicine physician and medical billing expert. A dedicated patient advocate, Dr. Virgie earned her degree at the University of Michigan Medical School and trained at the Cambridge Hospital of Harvard Medical School.

After practicing more than 20 years in primary care and psychiatric settings and as a health insurance executive, Dr. Virgie now helps patients understand complex medical procedures, communicate effectively with their healthcare providers, and avoid financial devastation from crushing medical bills through her What Your Doctor Wants You to Know series. Dr. Virgie is a former NY1 News health contributor and has been featured in Dallas Fox News, several podcasts, and national magazines. Learn more at


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